How To Manage Diabetes While Suffering From Crohn's Disease?

Posted on Tue, 31 May 2016

Question: I have been currently diagnosed as Diabetic which could be side effects of the multiple medicines I take for Chrons, Thyroid and related. Currently my Chrons is again active and having a lot of issues. I bleed in stools. I feel too dizzy. No matter how much I eat, I am eternally hungry because I run to the washroom within 20-25 mins of having food. I fear that this could lead to mismanagement of diabetes. I am already worried on how to manage my diabetes as I have not informed my family about this disease and cannot do for some more time. Kindly help.

Answered by Dr. Dr. Abhay A Mali (53 minutes later)

Brief Answer:
Need to modify antidiabetic medicines depending upon blood sugar levels.

Detailed Answer:
Hi Mr. XXXXXXX

Thanks for your question.
Sorry to know about your condition.

Depending upon your blood sugar levels (Fasting, Post-prandial & HbA1c), Kidney and heart function, I may suggest use of antidiabetic medicines which are rarely cause hypoglycemia (low blood sugar levels) even in patients with variable food intake.

At present you are taking Tab Cyblex M which contains Giclazide 60mg & Metformin 500mg.

Metformin is good as it very rarely cause hypoglycemia but it may not be used in full dose in your case as it may cause stomach upset (which may aggravate symptoms of crohn's disease).

Gliclazide is a insulin secreting drug. Insulin secreting action is independent of food intake. Hence drugs from similar group usually associated with hypoglycemia in patient with variable food intake.

Your symptoms of dizziness may be related to hypoglycemia which can be easily confirmed by doing blood sugar level by home glucometer during episode of dizziness.
Otherwise if symptom of dizziness get relieved after eating sugar containing food it may be related to hypoglycemia ie. effect of Giclazide.

In such case I may suggest to stop Tab Cyblex M & to increase the dose of Metformin to 1gram in divided doses with close monitoring of symptoms related to stomach upset and blood sugar levels.
Depending upon blood sugar level if required I may add DPP4 inhibitors (like Sitagliptin, Linagliptin, Tineligliptin).

You should discuss this with your treating doctor.

Also both Crohn's disease & Diabetes are life long disease you should reveal it with your close family members. You can take help of your treating doctor for same.

Hope this helps you.

Regards,

Dr. Abhay Mali.
Diabetologist.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Abhay A Mali (24 minutes later)

Thank you for the response Dr. Abhay. This helps me understand why the Chrons is now more active than before. Do you recommend that I visit a Diabetologist or an endocrinologist? Also want to check if I need to consult a gastroenterologist or will it be taken care with my visit to the diabetes specialist?

Answered by Dr. Dr. Abhay A Mali (20 hours later)

Brief Answer:
Required combined help of diabetologist & gastroenterologist.

Detailed Answer:
Thanks,

In your case there is need for combined involvement of Diabetologist or Endocrinologist, Dietician & Gastroenterologist.

Hope this helps you.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Abhay A Mali (31 hours later)

Hello Doctor Abhay,

I visited an endocrinologist in my howetown and she suggested me to get on insulin doses right away. To be honest, I am scared after all that she suggested.

Is there a way you could suggest any alternative medicine in place of Cyblex M 60? She did suggest that Metaformin should be avoided and I am overall more confused.

I would also like to mention that I have severe ED and also the foreskin doesn't pullback. I have a slight burning sensation on the penile area, thankfully not when passing urine.

One last question, My wife and I were thinking of having another child. With the numerous diseases that I currently suffer from, will the child inherit any/all? I am too worried on this too. She is not pregnant now but planning to have a child once my ED and foreskin issue is resolved.

Kindly Help.

Thanks,
XXXX XXXXXXX

Answered by Dr. Dr. Abhay A Mali (13 hours later)

Brief Answer:
Follow the advise of endocrinologist.

Detailed Answer:
Hi,

It is better for you to follow endocrinologist's advise, as he personally went through your case also done your physical examination.

In your case there may be major issue with use of metformin like-
- Stomach upset attributable to metformin use.
- Kidney issue like raised serum creatinine.
- Heart issue like decreased ejection fraction on 2DEcho.
- Active infection due to para-phimosis (inability to retract penile fore skin) as you have mentioned.
- Complications of uncontrolled blood sugar level which warrants rapid blood sugar control Erectile dysfunction is one of them.

There may be certain benefits of insulin in your case.
- Insulin is a what is deficient in diabetes we are providing in ready made form.
- Rapid control of blood sugar level.
- Can be used safely in kidney or heart dysfunction.
- No harmful effect on any organ.

Only issue with use of insulin may be hypoglycaemia which can be overcome with adequate knowledge of insulin use & hypoglycaemia (prevention, early detection & rapid correction).
Instead of becoming panic you should enhance your knowledge about safe insulin use.

You should plan pregnancy after good blood sugar control with consultation with your endocrinologist and gastroenterologist.

Hope this helps you.

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Sonia Raina